title: Risk factors of ischemic lesions related to cerebral angiography and neuro-interventional procedures.
abstract: Embolic stroke is not a rare complication of cerebral angiography. The risk factors for incidental embolism after cerebral angiography were retrospectively examined using diffusion-weighted magnetic resonance imaging (DWI) in 180 patients who underwent 247 angiography procedures, consisting of 174 diagnostic angiography and 73 interventional procedures, and magnetic resonance imaging including DWI within 72 hours after angiography. The two neuroradiologists in our hospital detected embolism after cerebral angiography as high-intensity lesions (HIL) on DWI. The relationships between HIL on DWI and procedural factors were evaluated. DWI after cerebral angiography revealed HIL related to the procedure in 72 of 247 angiographies. In all procedures, age (p < 0.01), past history of cerebral infarction (p < 0.05), anti-platelet therapy (p < 0.05), neuro-intervention (p < 0.01), and total amount of contrast medium (odds ratio [OR] 2.125, 95% confidence interval [CI] 1.045-4.321) were significantly correlated with HIL. In diagnostic angiography, the performance of the procedure by a resident operator (OR 2.526, 95% CI 1.214-5.254) was significantly correlated with HIL. Age, past history of cerebral infarction, and previous anti-platelet therapy determined the risk of atherosclerotic changes in patients. The neuro-intervention and total amount of contrast medium used could predict the risk of time limitations for angiography. Resident operator is also a risk factor. This study demonstrates the importance of improving the risk of time limitations for angiography and the risk due to operator inexperience. Further training of residents may be needed to reduce the occurrence of embolic complications.
authors.affiliation: Department of Neurosurgery, University of Tsukuba, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sato
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Nakai
authors.forename: Hideo
authors.initials: H
authors.lastname: Tsurushima
authors.forename: Masanari
authors.initials: M
authors.lastname: Shiigai
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Masumoto
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003287:Contrast Media / Q000009:adverse effects; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015642:Radiology, Interventional; D012008:Recurrence; D012307:Risk Factors; D013223:Statistics as Topic; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010975:Platelet Aggregation Inhibitors